Investigation On Medication Adherence In Patients With Gout At Home And Management Strategies

ObjectiveThis study aims to investigate the current situation of medication adherence in gout patients at home,analyze the factors which affect the medication adherence of patients with gout at home.Also it is designed to explore the current state of guide-based evidence for gout management,and to combine high-quality management suggestions with the survey results,so,the medication adherence management strategies for gout patients at home can be initially formulated.Methods1.Cross sectional investigation was utilized for 476 patients who suffer from gout in Shandong Gout Clinical Medical Center during February to June 2019.In this process what they use is a specifically-designed questionnaire in general,together with Morisky Medication Adherence Scale,Perceived Social Support Scale,Engagement with Health Care Provider,Treatment Satisfaction Qusetionnaire for Medication,Chinese Version of Gout Impact Scale,Beliefs about Medication Questionaire and The Self-Efficacy for Appropriate Medication Use Scale.Except for the disease-related information,which is filled in by the researcher according to the patients’ outpatient medical record,the rest of the questionnaire is filled in by the patients or thier family members,so the researcher completes the charts based on patients’ real thought.The data are analyzed by SPSS 22.0 software package.The medication adherence level of gout patients at home with different characteristics is compared by independent sample t test or one-way ANOVA.Pearson correlation or Spearman correlation was used to analyze the correlation between each variable and medication adherence.And multivariate stepwise regression analysis are used to analyze the factors affecting medication adherence.2.We searches databases home and abroad that established to February 2020 in a systematic way such as PubMed,Cochrane Library,Dynamed,Up to Date,Best Practice,China National Knowledge Infrastructure,Wanfang Data,China Biology Medicine disc as well as evidence-based guidelines websites such as GIN,NGC,NICE,and SIGN.The AGREE II scale is used to evaluate the quality of the included guidelines.We combine the pooled evidence of high quality with cross-sectional survey results to preliminarily develop management strategies to improve the medication adherence for home-based gout patients.ResultsIn this study,a total of 500 questionnaires are sent out,487 of which are recovered,and 476 of which are finally included in the effective questionnaire.The effective rate of the questionnaire is 95.20%.1.Medication adherence status: the adherence score of gout patients at home is(4.82 ± 2.22).The adherence scores are divided into three categories: good,medium and bad.61.55% of them had poor adherence.The specific analysis finds that 54.41% of the patients forgot to take the medicine.But 64.50% of the patients did not forget to take the medicine in the past two weeks.61.34% of the patients would not reduced the dosage or stop taking medicine when their symptoms got worse,but 52.31% of the patients would stop taking medicine when their symptoms were controlled.62.61% of the patients did not take medicine the day before the investigation.61.97% of the patients consciously adhered to the gout treatment plan without difficulty,and only 1.05% of the patients thought that it was difficult to remember to take the medicine on time.2.Many factors affact the medication adherence of patients: different age,average income per person in family,drinking condition,course of disease,time of taking medicine,frequency of attack,serum uric acid and whether there was complication(all P<0.05);correlation analysis shows that all other variables are correlated with the compliance of taking medicine except for the family support(all P<0.05).3.The results of multiple stepwise regression analysis shows that main fatots that affect their medication adherence are serum uric acid,average income per person in family,alcohol consumption,medication time,gout medication side effects,convenient use,self-efficacy of medication,unmet gout treatment need,medication concerns and medication necessity.The above ten variables can explain 37.25% of the variance of total aherence of gout medications.4.After a systematic search and screening,11 guidelines for gout management are finally included and two guidelines are combined.Europe is the most common region where guidelines are issued(4 articles),where the release institutions are mainly scientific research societies.Guidelines are issued or updated in the last decade.After evaluation by the AGREE II scale,the mean scores of all six dimensions evaluated in the 11 guidelines is ≥ 60%.And 11 guidelines are evaluated ≥ 60% in terms of the “Clarity of Presentation” dimension.However,four guidelines are evaluated ≤ 30% in terms of the “Editorial Independence” dimension.We extract the management of gout medication therapy in three aspects: “medication regimen”,“patient education” and “follow-up monitoring” after a detailed study of the included guidelines.Conclusions1.The adherence level of gout patients at home is poor.The adherence of them are affected by serum uric acid,average income per person in family,alcohol consumption,medication time,gout medication side effects,convenient use,self-efficacy of medication,unmet gout treatment need,medication concerns and medication necessity of taking medicine.2.Global gout management guidelines are rigorous and scientific.Combined with the guidelines and the results of our study,it suggests that the health care system can manage gout patients at home in terms of standardized medication regimen,medication guidance,socioeconomic support,and supervision and follow-up to improve their medication adherence.